First hilar cholangiocarcinoma patient to be treated with such a transplant looks ahead

After going through a battery of tests and speaking to various doctors, Mr Thangavelow Segaran, 49, was downcast.

He was told he had between six months and five years left to live, due to a rare bile duct cancer known as hilar cholangiocarcinoma. That was in February last year.

But he is no longer counting down his days. Last December, the former army regular became the first hilar cholangiocarcinoma patient in Singapore to be treated using a liver transplant. And he has remained cancer-free since.

The cancer, which has a low survival rate, affects only three in 100,000 people.

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Treatment methods were previously limited to chemotherapy and resection of the liver, which is to cut out the part of the organ and bile duct affected by cancer.

However, treatment using resection of the liver was an option for only 25 per cent of cases.

3

Out of 100,000 people are affected by hilar cholangiocarcinoma, which has a low survival rate

25%

Hilar cholangiocarcinoma cases that can be treated using resection of the liver

21/2

The number of years that such patients can generally survive on chemotherapy

5

Survival rate in number of years of more than 70 per cent for patients who had a liver transplant, according to European medical centres

Mr Segaran did not have that option as the tumour was in both the left and right side of the bile duct. The bile duct is a pathway that transports bile from the liver to the small intestine for digestion.

Patients on chemotherapy generally survive less than 21/2 years.

Living donor transplants more common in Asian countries

Besides cancer, liver transplants may be used to treat patients with liver failure or diseases such as viral hepatitis, cirrhosis (scarring of the liver) or liver damage from alcohol or drug abuse.

There were 256 liver transplants here between 2004 and 2015, according to the Ministry of Health. Of these, 157 were deceased donor transplants and 99 were from living donors.

In Western countries, deceased donor liver transplants are more common than living related donors, said Professor Pierce Chow, senior consultant surgeon at National Cancer Centre Singapore (NCCS). "The reverse is true in most Asian countries. This lowers the waiting time for those who need transplants."

But not all liver cancer patients need transplants, he said.

Early-stage hepatocellular carcinoma, which affects more than 90 per cent of primary liver cancer cases, can be treated via resection - surgically removing the affected part of the liver.

An analysis of more than 4,000 cases showed a survival rate of 65 per cent at five years, he added.

According to NCCS, liver cancer is mainly an Asian disease. It affects 24 out of 100,000 people.

Singapore Clinical Research Institute chief executive officer Teoh Yee Leong said the incidence has fallen from 2008 to 2012. This is due to the national hepatitis vaccination programme for newborns, started in 1987. He said that fatty liver disease is now one of the emerging causes of primary liver cancer.

Abigail Ng

The first sign of trouble for Mr Segaran emerged in February last year: mild jaundice, dark-coloured urine and white stools. These signs pointed to a liver-related disease.

Doctors at Changi General Hospital diagnosed him with bile duct cancer, but advised him and his wife to seek a second opinion. The couple have three children.

Mrs Nunthini Segaran, 40, said: "I cried. Of course, I did. It was all very overwhelming."

Statistics from European medical centres released last year showed a five-year survival rate of more than 70 per cent for patients who had a liver transplant.

The criteria, however, were specific. Tumours in the bile duct could not be larger than 3cm and the cancer must not have spread anywhere beyond the liver.

Mr Segaran sought treatment with Dr Stephen Chang at National University Hospital.

The liver specialist later performed the transplant operation at Mount Elizabeth Hospital where he runs a private practice.

He underwent 12 rounds of chemotherapy and scans showed his tumour was shrinking. The doctors also did not find cancer cells outside his liver, thus fulfilling the criteria for the transplant.

But other health problems caused some hesitation about the transplant operation.

Mr Segaran had two cardiac arrests and was hospitalised for kidney failure.

It took months of discussion before the couple decided to go ahead with the transplant to treat the cancer.

Mrs Segaran put out a request on social media platforms for donors and more than 10 people responded. Her cousin was selected to be the donor.

Friends and former colleagues rallied around them throughout the course of treatment, for which Mr Segaran is grateful.

He said: "They assigned teams and drew up a duty roster. One team would take me home from hospital and another would bring food for me."

He and his wife made the effort to stay positive. "Our motto was to wake up every day smiling, happy and laughing," she said.

However, his recovery was not without a few bumps. Two days after his discharge, he suffered from a bile duct leak, resulting in severe abdominal pain, and had to return to hospital for treatment.

But the family kept looking ahead.

"Even when I was recovering from surgery, I kept thinking about the future," said Mr Segaran.

The couple started planning to set up a mini-mart business. They received the keys to the premises when Mr Segaran was discharged.

They are now running EcoSphere Mart in Simei Street 1.

As they move on beyond the trying period, Mrs Segaran said: "This cancer has brought us closer together. It has taught us what it means to be patient, tolerant and understanding."

Correction note: The story was edited for clarity.

A version of this article appeared in the print edition of The Straits Times on May 16, 2017, with the headline 'Cancer-free after liver transplant'. Print Edition | Subscribe

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